Third Party Administration for Workers Compensation
Closed State & local contract opportunity
- Solicitation number
- 230084
- State
- Arizona
- Responses due
Opportunity facts
- Jurisdiction
- NIGP codes
- UNSPSC codes
- 84131613 Claims payment processing or administration
- 64122304 Employment practice liability insurance contract
- 84131904 Fiduciary liability insurance services
- 71161612 Technical consultant services for asset integrity information and data control
- 84131902 Professional errors and omissions liability insurance services
- 64122305 Workers compensation insurance
- 71161611 Technical consultant services for claim management
- 78142101 Claim management
- 84131607 Liability insurance
- 64122301 Professional errors and omissions liability insurance contract
Show all 19
- 84131516 Professional indemnity insurance
- 84131605 Workmens insurance
- 78141506 Freight, including insurance services
- 64122302 Directors and officers liability insurance contract
- 64122303 Fiduciary liability insurance contract
- 84131510 Contractors all risks insurance
- 84131903 Directors and officers liability insurance services
- 84131901 Workers' compensation insurance service
- 81162305 Risk management process as a service
- Point of contact
-
- Ladd Lyons ladd.lyons@tucsonaz.gov (520) 837-4113
Opportunity details come from procurement.opengov.com. Updated .
About this opportunity
The City of Tucson is seeking proposals for Third Party Administration (TPA) services for workers' compensation claims through Request for Proposal No. 230084. The solicitation is targeting specialist firms to provide comprehensive claims administration services for the city's approximately 4,750 employees, with an average of 453 claims filed annually over the past five years. The city is seeking both bundled and unbundled proposals, with a preference for a fully bundled solution that includes services such as comprehensive bill review and audit, utilization review, pharmacy benefit management, PPO and network services, Medicare Set-aside preparation, CMS lien investigation, telephonic and field case management, and other related workers' compensation claims services. Key requirements include maintaining an Arizona-based office, having appropriately licensed adjusters, and providing robust quarterly and annual reporting on claim activities and cost containment. The non-mandatory pre-submittal conference is scheduled for May 9, 2023, at 10:30 am via Microsoft Teams, with proposals due on May 25, 2023, at 2:00 P.M. local Arizona time. The city expects the TPA to provide data demonstrating successful outcomes and added value of ancillary services every six months and to list vendors providing these services.
The solicitation does not explicitly outline specific set-aside designations, but the City of Tucson's documents suggest potential alignment with Section 3 Program guidelines, which prioritize local economic development and opportunities for low-income workers and businesses. The city is a full-service, qualified self-insurer authorized by the Industrial Commission of Arizona and reserves the right to potentially perform some services in-house in subsequent years. While no incumbent vendors are specifically named, the TPA is required to list vendors providing ancillary services, including their service descriptions and relationship duration. The contract is structured as a multi-year agreement, with the potential for future modifications based on service performance. Pricing details are included in the accompanying price proposal document, which allows for both comprehensive and itemized pricing across multiple service categories. The city's claims history indicates a consistent volume of claims, with total claims ranging from 351 to 530 annually over the past five years, suggesting a stable and predictable workload for the selected TPA.
Opportunity text
The City of Tucson is seeking bundled and/or unbundled proposals from specialist firms for third party administration (TPA) services for workers' compensation claims, per specifications called for herein. The City is requesting that the Contractor provides a definition of an indemnity adjuster and medical only adjuster.
The City is looking for a best value solution with a multi-year TPA contract and is requesting bundled and/or unbundled responses from TPA's. The City may at a later date chose to perform any of these services in house. The city has a preference for a fully bundled solution but reserves the right in subsequent years to evaluate the value and performance of these ancillary services:
- Comprehensive Bill Review and Audit
- Utilization Review
- Pharmacy Benefit Management
- PPO and Other Network Services
- MSA Preparation
- CMS Lien Investigation
- Telephonic Case Management
- Field Case Management
- Other
The TPA shall be expected to provide data to demonstrate successful outcomes and added value of these ancillary services in six (6) month intervals. It is the expectation of the client that the TPA make recommendations and manage the use of the vendors necessary to provide these services. Finally we ask that you list the vendors that will be providing the above to include what services they provide and the length of your relationship with said vendor. If TPA will be providing any of the above services in house, please provide a list of these services.
The City is a full service, qualified self-insurer authorized by the Industrial Commission of Arizona. The City employs approximately 4750 employees and has filed an average of 453 claims per year for the last five years. The claims history for recent years is as follows:
Year Total Claim Indemnity Medical Only
2021/2022 351 136 215
2020/2021 426 166 260
2019/2020 478 191 287
2018/2019 483 170 313
2017/2018 530 171 359
The Contractor must be experienced in administering claims in accordance with Arizona Workers Compensation law and will provide services for all workers compensation claims for the City including new claims and run-off or "tail" claims. Offerors must carefully examine the Scope of Work to determine the risks to be covered. The City will assume that each Offeror has made such investigations and is fully informed of the extent and character of any and all requirements included in the Scope of Work.
The contractor will be licensed to conduct business in the State of Arizona. The Contractor agrees that all services performed pursuant to the Contract will be rendered through an Arizona-based office. The employees assigned to work under the Contract will have the appropriate adjuster's license, experience and training applicable to the types of claims they are handling, i.e. Senior Adjusters must have the experience to properly handle indemnity claims in accordance with Arizona Workers Compensation law. The Contractor will assign dedicated adjusters to the City with no more than 100 indemnity claims per indemnity adjuster and no more than 200 medical only and/or low activity claims to medical only adjusters. Assigned adjusters must be permanent employees of the contractor (non-permanent employees are not permitted assignments under this contract). The City retains the right at any time during the Contract to prohibit any of the Contractor's staff from performing services on behalf of the City. The City may request a specific staff member employed by the Contractor to perform one or more particular assignments.
Failure to maintain and adequately staff an Arizona-based office, perform all claims services timely and competently in compliance with Arizona workers compensation law, and to protect the City's interests at all times against actions resulting in a conclusion of bad faith by the City, will be a material breach of the Contract and will be grounds for termination of the contract. The City reserves the right to unbundle specific elements of service associated with the City's workers compensation claims. These can include, but are not limited to medical case management, bill review cost containment, utilization review, and pharmacy benefit management.
Offeror should submit a response in both PDF and WORD unprotected.
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